States Take Multiple Tacks Toward Easing Health Worker Shortage

The COVID-19 pandemic has laid bare any number of societal vulnerabilities, perhaps none more so than a growing shortage of health care workers some observers say is fast reaching crisis levels.

With that shortfall expected to only get worse in the coming years, states are now scrambling to implement a wide range of strategies they hope will get more nurses, doctors and other practitioners into the field as fast as possible.

Health Workforce Shortfalls Big and Getting Bigger

While the pandemic has certainly exacerbated the problem, the health workforce faced a staffing problem long before COVID became a household word.

According to a recent survey by the American Hospital Association, vacancies in various nursing practices increased by as much as 30 percent between 2019 and 2020. Association of American Medical Colleges (AAMC) data shows that by 2019 – a year before COVID – the U.S. already had approximately 20,000 fewer physicians than needed to meet its basic health care needs. The AAMC further estimates that the shortfall will reach 124,000 by 2034. Almost 40 percent of those unfilled positions will be for primary care doctors, the backbone of the nation’s health system.  

The situation for nurses and other medical care providers is even more dire. Data from the U.S. Bureau of Labor Statistics estimates approximately 195,000 nursing vacancies per year through 2030. A 2018 survey by consulting firm Mercer shows by 2025 the U.S. will face a shortage of almost 30,000 registered nurses, 95,000 nursing assistants, over 98,000 lab technicians, and 446,000 home health aides.

According to a 2021 study by Mercer, the number of lower-wage health workers is also bound to take a major hit. As of 2021, there were around 9.7 million workers in these critical positions, with the total need expected to swell to 10.7 million over the next few years. But if current trends hold, as many as 6.5 million workers will leave the profession, with only around 1.7 million stepping in to replace them.

Pandemic Stress, Boomer Retirements Driving Shortages

COVID-19 didn’t create the health worker shortfall, but it has made the problem worse, particularly in hospitals and long-term care facilities.

The American Hospital Association says hospitals have lost 105,000 employees since February 2020, and at least 23 percent of U.S. hospitals have reported a critical staffing shortage in that time.

The AHA further notes that over 35 percent of hospitals reported a nurse staffing shortfall of at least 10 percent, a significant jump from the approximately 24 percent of hospitals reporting such a deficit pre-pandemic. And 95 percent of hospitals reported hiring contract staff to help manage COVID-19 patients.

In all, data analysis from nonprofit health research firm Altarum Institute shows the health care industry lost 450,000 workers between February 2020 and December 2021, approximately 2.7 percent of the total health workforce.

Altarum Senior Economist Ani Turner notes that the figure does not account for regional fluctuations.

The pandemic is also not the only driver here. Numerous studies and anecdotal evidence point to an aging workforce, burnout and stress and the high cost of the education necessary for entry into the field as contributing factors.

Even with that, there is no lack of students wanting to get into nursing around the country. But teaching positions pay substantially less than what an RN can make in non-academic work, making it very hard for schools to attract enough qualified faculty to accommodate all the students who want in.

So What Are States Doing About All This?

Based on a recent uptick in policy proposals, the situation has clearly gotten the attention of both state and federal lawmakers says Hemi Tewarson, Executive Director of the National Academy for State Health Policy (NASHP), a nonpartisan forum of policymakers throughout state governments. 

Tewarson, who previously served as director for the Health Division of the National Governors Association’s Center for Best Practices, says health workforce issues have always been important to governors. Even so, those issues have rarely been near the top of their list of legislative priorities and almost never something they make a point of mentioning in their annual State of the State addresses. This year, at least 20 governors listed health care workforce issues in those addresses.

“I think that was significant,” she says. “As a result of the pandemic, people are simply needing a lot more services. Every state is having some level of challenge, and it really seems to be reflected in their leadership.”

Governors, Lawmakers Push Numerous Health Workforce Efforts

The proposals governors have championed this year run a gamut of policy initiatives.

As part of her budget, New York Gov. Kathy Hochul (D) has proposed a $10 billion plan she says will grow the Empire State’s health workforce by 20 percent over the next five years. Her plan would include $4 billion to fund higher wages and retention bonuses for health workers and another $2 billion to fund health care infrastructure. Other tenets include tuition waivers and funding for new training programs.

Illinois Gov. J.B. Pritzker’s (D) budget proposal includes $25 million for recruiting and training new health care workers and other funding for scholarships and loan forgiveness plans. 

Georgia Gov. Brian Kemp, Iowa Gov. Kim Reynolds, and Tennessee Gov. Bill Lee, all Republicans, also committed millions of dollars toward training or recruiting new health workers for their states.

Other governors dedicated significant funds toward workforce issues in specific workforce areas, such as maternal health, Medicaid reimbursement rates, mental health and substance abuse disorders.

Vermont Gov. Phil Scott (R) also signed legislation in March that allows health workers in other states to continue serving residents of his state via telehealth options.

New Jersey Gov. Phil Murphy’s (D) budget includes $211 million for wage hikes for “home health aides also known as personal care assistants, child care workers, nursing home workers, private duty nurses, community-based mental health and substance use disorder providers, and homeless shelter staff.”

And just this month, the National Governors Association announced the start of a six-month multi-state program collaboration aimed at addressing the workforce shortage. California, Colorado, Wyoming, and Missouri are the primary states, while 10 more – Alabama, Connecticut, North Carolina, Ohio, Oregon, Rhode Island, South Carolina, Utah, Wisconsin, and West Virginia – are satellite members.

Lawmakers have also got into the act, as the State Net legislative and regulatory tracking database shows at least 20 states and the District of Columbia have introduced health workforce bills this year.

Heather Young, a professor of nursing at the University of California, Davis and the national director for the Betty Irene Moore Fellowship Program for Nurse Leaders and Innovators, is thrilled to see such efforts. She also has a suggestion she hopes federal lawmakers will consider: funding more nurse residency programs. She says there are a handful of state and privately-funded programs, but no national program.

“What we found is that people can finish nursing school but they end up dropping out of the workforce early on because they are really challenged by that transition into practice,” she says. “We spend all that money getting them ready to go, and then they find the practice so difficult that they don’t stay on. To me, that’s a travesty.”

Editor’s Note: This is the first in what we plan to be multiple looks at this complex issue. Coming up soon – the role nurse staffing ratios play in all this.

--By RICH EHISEN

State Lawmakers Focusing on Healthcare Workforce

Lawmakers in at least 20 states have introduced legislation this session dealing substantively with the healthcare workforce, including measures creating workforce development task forces or commissions, establishing healthcare worker training programs, and providing for medical education assistance. Four of those states have enacted such measures.